Comprehensive Outcome of Repair of Small Paraumbilical Hernias by Onlay Mesh Hernioplasty under Local Anesthesia

Abstract

Introduction: Repair of paraumbilical hernia by mesh Hernioplasty is a common surgical procedure done worldwide. The ideal site for mesh reinforcement is still debatable and many studies are in progress to show the equally effective outcomes of on lay and sub lay mesh reinforcement. Moreover, mesh reinforcement under local anesthesia makes the procedure safer and less complicated. Objective: The present study was to evaluate the outcome of repair of paraumbilical hernia by onlay mesh under local anesthesia in terms of repair, pain and complications. Subjects and Methods: i. Study Design: Clinical Trial ii. Study Setting: Department of Surgery Unit III, Allama Iqbal Medical College / Jinnah Hospital Lahore. iii. Study Duration: From January 2000 to June2016 iv. Sample selection: Non-probability / consecutive sampling v. Data Collection and analysis: A prospective non-randomized clinical trial done. Sample size was 500 patients (350 females and 150 males) age ranging from 25 to 75 years. Patients having small paraumbilical hernia of 0.5 - 4 cm abdominal wall defects, which were repaired by onlay mesh reinforcement using prosthetic prolene mesh under local anesthesia. Outcome was measured in terms repair, pain at incision site at 6 and 12 hours and complications. Data was entered and analyzed in SPSS ver: 21.0 and outcome was presented as frequency and percentages. Results: Out of 500 patients, 120 patients (95 females and 25 males) had chronic liver disease and ascites. 35 had oozing of serous discharge from the hernia. Females included multiparous 93%, primiparous 6% and nulliparous 1% were most affected (70% females & 30% males). Mean age of the patients were 43 + 11.01 years (p < 0.05). Post-operative pain measures on VAS were 2 + 0.45 at 12 hours.1.6% (08) patients developed Seroma and 1.0% (05) had wound infections. Conclusion: Onlay mesh reinforcement under local anaesthesia was found to be safer, cost effective, associated with minimum chance of post-operative complications and early return to normal life.